The number of intensive care beds at University Hospital Galway is set to more than double as the west’s biggest hospital prepares for the anticipated upsurge in Covid-19 cases in the coming weeks.
As the global pandemic exerts huge pressure on health services, Tony Canavan, the chief executive of the Saolta University Health Care Group which runs the local public hospitals, said preparations are being finalised to ensure these facilities will meet the escalating demands being imposed on them by the coronavirus.
Intensive care beds at UHG are to be increased from 22 to 50, a number of staff from other areas of the hospital have been upskilled to augment ICU staffing levels, and the hospital has been reconfigured to separate suspected and confirmed Covid-19 patients from others, in terms of being admitted and accommodated. Any vacant general hospital beds are also being maintained that way as part of the 700-bed hospital’s action plan against this powerful and dangerous infection.
The 200-bed Portiuncula Hospital in Ballinasloe has taken the same steps. Its intensive care unit is to double its capacity from four to eight beds.
Mr Canavan’s comments came as the latest figures (at the time of going to press on Wednesday evening ) indicated there were 86 cases of Covid-19 in Galway.
He said hospital employees, across every discipline, were working tirelessly to ensure patients would receive the best possible treatment and thanked the public for playing such a vital role in limiting the spread of the virus by observing government directives. He appealed to people to continue to abide by these requests and said this would help the health service greatly in its response to this national emergency.
Frontline heroes — Staff from the Orthopaedic Outpatients and Physiotherapy Departments in Merlin Park University Hospital.
“All three local Saolta hospitals, University Hospital Galway, Portiuncula University Hospital, Ballinasloe, and Mayo University Hospital have stepped up their final preparations for the anticipated rise in Covid-19 cases. We see ourselves now as being in the escalation phase of the virus.
“We are specifically working on the pathways of care for those who have the virus or are suspected of having it. The idea is that they would be able to come into hospital through a separate stream or partitioned area to be assessed and evaluated and receive care provision also in a separate stream.
“We have been making physical changes in each of our hospitals in this regard. When you come to the door of the emergency department of UHG, for example, there is a physical division. Work was carried out on this over the weekend. This is also the case at Portiuncula University Hospital.”
He said Saolta’s second key priority is increasing the number of beds at its intensive care units. “Today we have 22 ICU beds at UHG. We hope to increase this to 50 on a phased basis, as required. We are taking the exact same approach to the ICUs in our other [local] hospitals. We currently have four ICU beds in Portiuncula University Hospital and we hope to increase those numbers considerably, at a minimum, to eight beds. All our hospitals are ready to increase capacity on a phased basis, straight away, if needed.
“The most important difference between ICU beds and other beds is the level and skills of the staff involved. Nursing ratios are very high in ICUs, these are where the sickest people, who require the highest level of medical and nursing care, are looked after. We have great medical teams in our ICUs and have been training up our own existing staff [to supplement current ICU staff levels] to work in these units to meet future needs. Some 250 staff have been trained over the last four weeks, these are nursing staff and therapists, such as physiotherapists, speech and language therapists, occupational therapists, etc. These are currently working in our hospitals but are now trained if we need them to work in our ICUs.
“Regarding how long patients stay in ICUs, it depends on the individual. Patients admitted with Covid-19 would on average remain there for two weeks.” He stressed while the number of people who contract Covid-19 will be a minority, nonetheless this will be a “significant minority”.
Mary McLoughlin, Medical Scientist, in the main virology laboratory at UHG.
Mr Canavan said Saolta is also focusing on retaining as many general beds as possible in its hospitals. “The third area we are working on is to ensure that we have as many ordinary beds as we can in our hospitals. We have a number of vacant beds, more than ever before, more than we would even have had on Christmas Day. I haven’t seem that in my 30 years in the [health[ service. One day last week there were about 20 per cent of our hospital beds across the group vacant.
“Three weeks ago we started to empty our hospitals, discharging people to other facilities, and as the number of patients arriving in hospital reduced we managed to maintain that position of empty beds. However, that leaves us with concerns that there are patients in the community that probably need hospital attention. We would remind them to come to the emergency department and they will be looked after. We would expect certain numbers and types of patients to turn up, for example those with underlying heart conditions. If you are unwell or have a health issue don’t be afraid to come, you will be looked after.
“The message we are very keen to get across to the public is keep up their efforts, this is not the time to get complacent. We need to adhere to Government regulations regarding going outside, maintaining social distancing, and coughing/sneezing etiquette. Don’t feel the work is done and dusted, it needs to be sustained, we need to stick with this. Slowing down the spread of the virus will help our hospitals.”
Keith Crawford and Nela Coric, Bidvest Noonan cleaning operatives at UHG.
Jean Kelly, the group director of nursing with the Saolta University Health Care organisation, said nurses and midwives at all its hospitals are busy preparing for the expected escalation in Covid-19 cases.
“We are preparing Covid-19 specific areas in hospitals and different pathways for admissions. Those coming in with a positive diagnosis for Covid are being streamed through a Covid pathway. We are trying to have two almost separate sections and everyone is trying their best to stream patients to the Covid pathway and non-Covid pathway. That is one of the streams of work going on.
“The second major work going on is changes in terms of nursing. Everybody is aware that patients with Covid-19 need a lot of critical care. We need to support our ICUs, we need to expand them. We have taken nurses who might have worked in ICU before and upskilled them. Our centres of nursing education are running courses daily to upskill staff who have put their hands up to go back to ICUs. We even ran education days on 17 March.
Reconfiguring entrances to hospital
“We also need to manage the areas [in the hospitals] where these staff are coming from. For the directors of nursing that is really difficult as we don’t have a lot of extra staff available. We are also looking at the [general] stream of patients such as chronic patients receiving dialysis, infusions, or chemotherapy. We have to protect them from the virus, this involves rethinking pathways, even the entrances into the hospital. What we have to look at is changing the times they are getting treated or having different entrances to the areas in which they are getting treated. In Ballinasloe and Mayo hospitals, for example, these patients are coming in by the back door.
“All hospitals to a greater or lesser extent have changed how patients are triaged. We have two mobile units outside UHG for this purpose, for Covid positive and negative people. We have these two streams going into our EDs in all our hospitals in Galway and Mayo. We have also changed the clinic times and staggered appointments for antenatal patients.”
Ms Kelly said all hospital staff have had to change how they work and provide services. “Logistically, this is huge and involves every discipline in the hospital. It is not just the nurses and doctors, it is the maintenance staff (we couldn’t have done what we did without our carpenters and plumbers ), our administration staff, porters, caterers, and cleaners. We want to thank all those people who are working behind the scenes and are not getting the hero tag. We don’t know where we would be without them.”
She is worried that patients needing vital care are not attending hospital as they normally would. “I would be concerned that the elderly, especially, are staying at home with chest pains or stroke symptoms, for example, because they are afraid of catching the virus or do not want to bother us. They are a vulnerable group and need to be treated.”